The points of departure in this article are questions regarding assessment in music education. These are related to issues of professional responsibility and accountability as well as a holistic view on education as conceptualized in Deweyean pragmatism and concern the risk of criteria compliance. A participatory action research project in a Swedish Upper secondary school focusing on assessment of music is presented, where the purpose of the research was to develop knowledge about music teachers’ experience and conceptualizations regarding assessment practices within the frame of the National Arts Programme. This is enabled by asking the following research questions: In what ways do teachers conceptualize musical knowledge and learning and educational communication in relation to assessment? What qualities appear within the teachers’ conceptualizations regarding knowledge, learning, communication and assessment of students’ knowledge? Aims from the field of praxis were integrated in the project, with focus on equivalent assessment and legal certainty. Results from the research project show the music teachers’ ability to shift between atomistic and holistic perspectives but at the same time keep their holistic view of assessment and learning. Equivalence is according to the teachers something different than uniformity, and is only possible through reflection and collaboration, internally as well as externally with other practitioners.
There is much discussion on what an athlete should be eating, but much less reference to drinking. Dehydration might decrease both aerobic and cognitive/mental performance. Overhydration might also impair physical ability, and pose a risk for exercise-associated hyponatremia. Athletes and coaches should anticipate possible fluid losses in prolonged events, and calculate appropriate drinking amounts to maintain euhydration. Body weight changes during similar events or training can be used to determine the amount of fluids to be ingested.
Intestinal failure is associated with loss of homeostatic mechanisms which can lead to metabolic instability which may be compounded by treatments such as parenteral nutrition. We report our experience of those patients on established Home Parenteral Nutrition who developed acute or chronic hyperchloraemic metabolic acidosis and acute hypochloraemic alkalosis, both hitherto poorly recognised problems. A retrospective observational single centre study of 39 consecutive patients under our care from 1989 to 2006 on home parenteral nutrition. In our cohort of 39 patients with intestinal failure, there were 11 episodes of acid–base disturbance in 10 (25.6%) patients. In 5 of these episodes the presentation was severe and associated with raised serum creatinine. The remaining 6 episodes followed a sub-clinical chronic course of acid–base abnormality detected on routine screening but only 1 of these had a raised serum creatinine. Proton pump inhibitors (PPI) were also considered a likely cause of some episodes of acidosis. Ileal conduit was present in 2 cases. None had d-lactic acidosis. Acid–base disturbance is an underreported complication of Home Parenteral Nutrition, occurring in around one quarter of our series but without evidence of d-lactic acidosis. This may be a severe complication of parenteral nutrition in patients with intestinal failure, particularly in patients with renal impairment, PPI treatment or ileal conduit. Chloride and bicarbonate should be monitored during home parenteral nutrition.
Optimal nutritional intakes are critical for health- and skill-related physical fitness. This course discusses 1) the effect of energy restriction and supplementation on physical fitness, 2) the optimal chronic macronutrient intakes for physical fitness in exercising subjects and 3) the impact of short-term intakes of macronutrients, before, during and after exercise, on physical fitness of athletes.
In Japan, supplemental vitamins are not always included during short-term peripheral parenteral nutrition (PPN) therapy. In addition, a dose of 100 mg/day of vitamin C shown in the 1975 AMA guideline for adult intravenous multi-vitamin formation, is inadequate to keep vitamin C levels in the normal range. We investigated the adequacy of 500 mg of supplemental vitamin C in patients with gastrointestinal disorders receiving short-term PPN therapy. We randomly assigned 16 in patients with gastrointestinal disorders who were scheduled to receive a 5 day continuous PPN intravenous infusion to a treatment group that received 500 mg/day of supplemental vitamin C or to a control group that received no vitamin C supplementation. Blood concentrations of vitamin C and indicators of inflammation were measured before and immediately after 3 and 5 days of vitamin C administration. Vitamin C and oxidative stress markers in 24 h, cumulative urine samples, collected and stored under light protection at 0 °C, were also measured before and on days 3 and 5 of supplementation. Mean blood vitamin C concentrations were below normal at baseline in both groups but returned to normal only in the treated group, on both days 3 and 5. Increases from the baseline were significantly larger in the treatment group than in the control group on both days. Mean urinary vitamin C excretion was above normal only in the treated group. Indications of inflammation and markers of oxidative stress did not differ markedly between-groups at any time. Poor vitamin C status in patients with gastrointestinal disorders receiving short-term PPN can be restored to normal with vitamin C supplementation at 500 mg/day.
Dietary recommendations for healthy food intake are an essential part of preventive strategies, food variety might offer one additional approach. Between January 2005 and September 2009, a total of 2548 persons attended a medical outdoor centre for diagnostic and/or therapeutic interventions. To obtain information on their nutrition behaviour, patients were requested to complete a 51-item semi-quantitative food frequency questionnaire. Frequencies of consumption of food items were reported on a scale between 1 (seldom or never) and 6 (more than once per day). To investigate the impact of nutrition patterns on the probability of cardiovascular event and/or medication we estimated four alternative versions of logistic regressions. Up to the age-decade 51–60 of years, the majority of the patients reported a moderate to high food consumption variety. A low variety was primarily found in the age decades older than 60 years. Within each age cohort, the predicted probability of cardiovascular events and/or medication was lower for patients with higher food variety. Our parameter estimates indicate that, on average, the consumption of one additional food item reduced the probability of a cardiovascular disease by about 0.5%. Adding overall daily intakes of energy or nutrient contents did not change this result. Our study shows that food diversity has a significant impact on the probability to stay healthy.
Trials assessing the effectiveness and safety of the Atkins diet for weight loss in obese diabetic patients are limited and adherence is problematic. The current trial compared an Atkins-like diet to a conventional ADA-recommended diet over a one year period. 52 type 2 diabetes patients, aged 35–75, BMI 30–39.9 kg/m2, HbA1c > 7%, treated by diet or oral medication, were initially placed on a DASH diet for one month, then randomly assigned to a modified Atkins diet (ATK) with unrestricted calorie intake or a standard American Diabetes Association (ADA) calorie-restricted diet. Weight, fasting blood glucose, lipid profile, blood pressure, and microalbuminuria were measured at baseline and after 1.5, 3, 6 and 12 months, and compliance with the diets was assessed. Similar weight loss and decrease in HbA1c were observed in both groups. Improvement in glycemic control and cardiovascular risk factor levels accompanied the modest weight reduction, with no significant between-group differences. ATK was not associated with untoward renal effects. Substantial drop-out in both groups was noted. There was no statistically significant advantage in terms of weight loss or glucose control for the Atkins-like diet. Adherence to a very low carbohydrate diet in a population accustomed to a Mediterranean-type diet rich in fruits and vegetables was modest, thus restricting its applicability to selected obese diabetes patients.
Body height and weight are required to screen for malnutrition. In practice, body weight and height are at times estimated based on nurses’ own judgements. How accurate are nurses’ estimations of body weight and height? Body weight and height of a volunteer simulating a bedridden patient was to be estimated by qualified nurses. One-tailed T-tests on the difference scores of the estimated and measured variables yielded significant results for weight and height, but not for body mass index suggesting significant differences between estimated and real parameters of weight and height. Multiple regression analyses showed no significant effect of nurses’ body weight or height on the difference score, nor did the nurses’ body mass index, age, gender and years of job experience yielded any significant results on any of the difference scores. Nurses’ estimations for weight and height are not accurate. One in four nurse participants classified the patient into a wrong category of body mass index. Deviations in estimated versus measured body weight and height are not influenced by nurses’ own body weight and height nor by their age, gender or years of job experience. These results are discussed in the line of existing research.
The energy used in post-prandial state during rest and physical activity is derived predominantly from the oxidation of carbohydrate (CHO) and fat. Although protein can also serve as a source of energy, amino acids oxidation is usually tightly adjusted to amino acids intake and their contribution to total energy expenditure is rather insignificant in healthy subjects. Blood glucose, glycogen, plasma fatty acids and intramuscular triglycerides, on the other hand, present major sources for energy production.
Many studies have demonstrated ω-3PUFA has anti-tumor effect, our previous study further proved that together with chemotherapy drug, PUFA can enhance chemotherapy sensitivity as well as anti-tumor effect. This study will further investigate the mechanism of enhancing chemotherapy sensitivity. In vitro cultivate human gastric cell line MGC-803, set 3 different contrast trials: control group-A, chemotherapy group-B (5-FU), n-PUFA with chemotherapy (5-FU) group-C. Compare 3 groups cells’ NF-κB activation status with dual-luciferase reporter assay and bioluminescent measurements, by using transient cotransfection with plasmid pNFκB-TK-Luc and internal control plasmid pRL-TK in MGC-803 cells. Meanwhile, compare 3 groups of the mRNA and protein expression of MMP-2, COX2, CyclinD1, which are the downstream regulation gene of NF-κB transduction pathway. NF-κB transduction was obviously activated in chemotherapy group-B, compared to the control group-A. However, in group-C, n-PUFA can blunt the NF-κB activation induced by chemotherapy. Meanwhile, the NF-κB’s downstream regulation genes, MMP-2, COX2 and CyclinD1 were also inhibited. ω-3PUFA can enhance chemotherapy sensitivity through inhibition of NF-κB transduction way. This study suggests a new concept of using clinical combination chemotherapy.
Many IBS patients believe that their symptoms are triggered by specific foods. However, demonstration of these food intolerances is difficult. True food allergy account for a minority of intolerances, whereas carbohydrate (i.e. lactose, fructose, sorbitol) malabsorption is easier to document. In general, patients with IBS can (and should) eat a balanced diet without restrictions, and (except for malabsorbed sugars) exclusion diets are not recommended.
Plasma antioxidant status after stroke is altered due to oxidative stress. We examined the antioxidant status after stroke and its association with survival in elderly with differing nutritional treatments. Acute stroke patients (>65 years) at nutritional risk were randomized to individualized, energy- and protein supplementation (intervention, n = 81) aiming to prevent undernutrition, or routine nutritional care (control, n = 85) during hospital stay. Plasma vitamin C, alpha-tocopherol, total carotenoids and glutathione redox potential were measured at study entry (baseline), after one week and after three months. This study is registered with ClinicalTrials.gov, number NCT00163007. In both study groups, high baseline plasma glutathione (GSH) reducing capacity reduced adjusted all-cause mortality risk with almost 50% compared to low GSH reducing capacity (P = 0.02) after a mean follow-up time of 25 months. Mortality risk in the intervention group was reduced in those with either the highest GSH reducing capacity (relative risk 0.39, P = 0.02) or the highest total carotenoids (relative risk 0.35, P = 0.03) compared to lowest antioxidant status. Higher antioxidant status may improve survival after stroke in patients at nutritional risk. Energy- and protein supplementation might further reduce mortality risk, at least in part due to improved nutritional intake.
Glutamine supplementation has beneficial effects on morbidity and mortality in critically ill patients. We investigated the effect of L-alanyl-L-glutamine dipeptide supplemented TPN on biochemical parameters, length of stay (LOS) and mortality in 30 critically patients. : Randomized, prospective, controlled, double-blind study in general intensive care ünit (ICU) in Guven hospital, Turkey. 30 patients admitted to the ICU and requiring TPN for more than 5 days. The patients were randomized and analyzed in two groups; Patients received either Gln-supplemented TPN (containing L-alanyl-L-glutamine dipeptide; 0.5 g/kg per day; n = 15) or standart Gln-free TPN (control group n = 15). Demographics, time of TPN, APACHE II score, type of diagnosis, biochemistry, nutritional, immune parameters, ICU LOS, ICU mortality, and in-hospital mortality were analyzed and compared. There were no difference between groups according to the demographics, APACHE II score, the duration of TPN, diagnosis, the biochemistry except albumin, nutritional and inflammatory parameters, ICU LOS, ICU mortality, and in-hospital mortality. After 2 weeks of treatment, in Gln-supplemented TPN group exhibited significant increases in serum albumin levels (P = 0.006). We found no biochemical and clinical difference between the two groups. Much trials will be necessary to identify a difference in our patient population.
To evaluate the scored patient-generated subjective global assessment (PG-SGA) as a nutrition assessment tool in subjects with chronic obstructive pulmonary disease. Seventy-two participants attending a pulmonary rehabilitation program (22M, 50F; mean age 66.6 ± 8.6 y). Nutritional status was assessed using the scored PG-SGA – global categorisation and score; fat free mass index. According to the subjective global assessment, 61 participants were well-nourished and 11 were moderately malnourished. Well-nourished participants had significantly lower PG-SGA scores (5.9 ± 3.0 vs 12.1 ± 5.4), higher % oxygen saturation (94.9 ± 2.8 vs 93.6 ± 2.4) and higher BMI (27.8 ± 6.1 vs 19.5 ± 3.2) than malnourished. There was a significant correlation between PG-SGA score and % oxygen saturation (r = −0.275, p = 0.026) and 6-min walking distance (r = −0.245, p = 0.044). The PG-SGA score had an 82% sensitivity and 79% specificity of predicting the global categorisation of nutritional status. The scored PG-SGA identifies malnutrition in participants with chronic obstructive pulmonary disease. The nutritional status of subjects attending pulmonary rehabilitation programs could be assessed and tracked with the scored PG-SGA.
In type 2 diabetic patients with dysphagia as a sequela of cerebrovascular accident, enteral nutrition tube feeding, especially with high-carbohydrate (CHO) standard formulas, may lead to acute glucose variation (GV). We assessed whether a low-CHO, diabetes-specific formula improves GV over 24 h using continuous glucose monitoring (CGM). Patients were fed either a low-CHO, diabetes-specific formula (henceforth, low-CHO formula) or a high-CHO standard formula (henceforth, high-CHO formula) for 2 days. Blood glucose (BG) was assessed by CGM throughout the observation period. Ten patients who received enteral tube feeding with the low-CHO formula had significantly (p < 0.01) lower 24-h mean BG than patients fed a high-CHO formula (123.2 ± 38.3 vs. 143.7 ± 58.1 mg/dL). Mean amplitude of glucose excursion was significantly (p < 0.01) lower in the low-CHO vs. high-CHO formula group, as was 24-h GV (p < 0.05). Percent period of hyperglycemia was significantly (p < 0.05) reduced when patients were fed low-CHO vs. high-CHO formula (16.8 ± 31.5% vs. 37.9 ± 33.0%); hypoglycemia was rarely observed. A low-CHO formula may enhance postprandial and fasting BG profiles and alleviate GV. It may therefore be useful for diabetic patients requiring enteral tube feeding.
The prevalence of undernutrition among older nursing home residents is high and has been associated with impaired muscle strength, functional limitations, reduced quality of life and increased health care costs. However, the causality of these associations is difficult to establish. The purpose of this paper is to review the literature on the effects of oral nutritional interventions on weight change and change in functional outcome in older nursing home residents and subsequently assess concordance. A literature search was performed, including randomised controlled studies that examined the effects of oral nutritional intervention on both body weight and functional outcomes. The level of concordance was determined by determining whether a parallel effect was shown on change in body weight and functional outcomes. Of the eight studies included, six found a beneficial effect on weight change. Of these six studies, two out of four that included muscle function found a beneficial effect on muscle function while one out of four that included Activities of Daily Living found a beneficial effect on Activities of Daily Living. All in all there was concordance in five of the eight studies included. There is some evidence for a positive effect on oral nutritional interventions on function through weight gain. However, larger randomised controlled trials are needed.
Ghrelin levels are associated with insulin resistance, obesity and clustered abnormalities of the metabolic syndrome. Nutrients, mainly carbohydrates, influence ghrelin secretion. Obestatin is derived from the same precursor as ghrelin. Contemporary regulation of the three peptides, with respect to insulin sensitivity and metabolic syndrome, remains undefined in childhood and adolescence. A cross-sectional study in a tertiary care center. Acylated, unacylated ghrelin, obestatin, glucose and insulin were measured at fasting and post oral glucose load in 60 pediatric obese and 22 normal weight subjects classified with respect to those alterations that cluster in metabolic syndrome. Acylated ghrelin decreased at 60 min and subsequently returned to basal levels (p < 0.001). Unacylated ghrelin and obestatin decreased for the entire test with a maximum inhibition at 60 and 120 min (p < 0.0001), respectively. Unacylated ghrelin inhibition was influenced by insulin sensitivity. The insulinogenic index was associated with the acylated ghrelin rebound (p < 0.002) and obestatin nadir (p < 0.006). Fasting unacylated ghrelin was reduced in metabolic syndrome due to insulin resistance. Obestatin variation was blunted in individuals who had alterations of the metabolic syndrome cluster (p < 0.0001), being predicted by lower HDL cholesterol and higher blood pressure. Acylated, unacylated ghrelin and obestatin present different dynamics after glucose load in pediatric individuals. Compensatory insulin secretion to insulin resistance and insulin sensitivity are the major contributors associated with the regulation of ghrelin as well as metabolic alterations with obestatin.
Supplementation with probiotic Bifidobacteria or Lactobacilli or the combination of both, has been shown to maintain a healthy balance of bacterial flora in the intestinal lumen. A placebo-controlled, crossover, self-comparing clinical study evaluated the probiotic effects of Lactobacillus fermentum P.C.C. (ProBioPCC) on gastrointestinal bacterial flora. This 8-week trial comprised an initial lead-in week with no study intervention, a 3-week treatment phase (taking ProBio, 1 capsule/day), a 1-week washout phase, a 3-week control phase (taking placebo, 1 capsule/day), followed by a final week of washout. Thirty healthy adults (age: 25–43 years) having no gastrointestinal diseases were recruited into the study. Stool samples were collected once at each experimental week, and cultured for counting colonies of total anaerobic bacteria, Lactobacillus spp., Bifidobacterium spp., and Clostridium perfringens. We found significantly increased colony counts of Lactobacillus spp. In stool samples after the treatment phase (p < 0.05). Colony counts of probiotic Bifidobacterium spp. were significantly increased with the study intervention (p < 0.05), while those of harmful C. perfringens were reduced (p < 0.05). Ratios of Bifidobacterium spp. to total anaerobic bacteria and to C. perfringes were increased significantly (p < 0.05). The bacteria colony counts and ratios returned toward baselines during and after the placebo control phase. In order to confirm the increase of intestinal probiotics was due to oral administration of ProBioPCC, we further demonstrated that L. fermentum P.C.C. strain was resistant against simulated gastric acid and bile in vitro. Our data indicate that ProBioPCC is effective in decreasing C. perfringens and increasing ratio of Bifidobacterium spp. to total anaerobic bacteria in healthy humans.
Liver transplantation is a major procedure often undertaken in patients in poor nutritional status. Few studies have examined the modification of nutritional status after liver transplantation. We aimed at analyzing the modification of nutritional status occurring in liver recipients during the first year. Twenty-five consecutive patients submitted to liver transplantation were studied. A complete nutritional assessment, was performed before and at 3, 6 and 12 months after transplantation. Insulin and C-peptide plasma levels were determined and insulin sensitivity was estimated. According to subjective global assessment 56% of patients were malnourished at transplant. In malnourished patients nutritional status further deteriorated at 3 months but improved 6 and 12 months after transplantation. Fat mass significantly increased from before to 12 months after transplant (median triceps skinfold: 10.8 vs 15.2 mm, p = 0.03) while parameters of muscle mass showed minor variations (median arm muscle circumference: 23.4 vs 24.0 cm, p = 0.3). The daily calorie intake also improved (27 vs 32 kcal/kg/die, p = 0.007) and protein intake increased (0.8 vs 1.3 g/kg, p = 0.02). In patients without malnutrition nutritional status and dietary intake showed minor variations after transplantation. Hyperinsulinemia was normalized and insulin sensitivity improved in all patients post-transplant. During the first 12 months after liver transplant a significant improvement in nutritional status is achieved in patients previously malnourished. Fat deposits show the more rapid improvement while the amelioration of muscle mass requires a longer period. The increased dietary intake and improved insulin sensitivity are associated to these changes.
The objectives of the study were to validate accuracy and reliability of the QUARK RMR, an indirect calorimeter versus the DELTATRAC II™, a well-established reference system which is no longer available, in resting and post-prandial conditions. A crossover, randomized study was performed in 30 subjects for two consecutive days. Resting metabolic rate (RMR) was measured for three 45 min periods using alternating calorimeters. Means of RMR were then compared with Pearson's test and Bland and Altman plot. Thermic effect of food (TEF) and substrate oxidation were assessed for 3 h with each calorimeter, 15 min after meal ingestion, and were compared by longitudinal analysis. Means at rest of VO2, VCO2, RMR and substrate oxidation were not significantly different with both devices. The variability of VO2, VCO2 and RMR measurements, at rest, for each device, on two consecutive days, was similar to that measured with QUARK RMR and DELTATRAC II™ the same day, under standardized conditions. Longitudinal analysis of TEF and post-prandial substrate oxidation was equivalent with the two devices. The QUARK RMR calorimeter seems to be a valid system to measure energy expenditure in resting and post-prandial conditions in obese and healthy subjects. Clinical Trial Registration Number: NCT00848471.
